Managed Care Activities definition

Managed Care Activities means any of the following services or activities, whether provided on paper, in person, electronically, or in any other form and whether performed for or on behalf of the Organization or by the Organization for itself or on behalf of any other party for a fee: Provider Selection; Utilization Review; Quality Improvement Organization Programs; advertising, marketing, selling, or enrollment for health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans; Claim Services; establishing health care provider networks including tiered networks; provision of information with respect to tiered networks and/or consumer directed health care plans, including cost and quality information regarding specific providers, services or charges; reviewing the quality of Medical Services or providing quality assurance; design or implementation of financial incentive plans; design and/or implementation of Pay for Performance Programs; wellness or health promotion education; development or implementation of clinical guidelines, practice parameters or protocols; triage for payment of Medical Services; calculation of medical loss ratio and related distribution; and services or activities performed in the administration or management of health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans.
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Managed Care Activities means any of the following services or activities performed by or on behalf of the Insured for or under any workers’ compensation plan, life insurance plan, disability plan, or health care plan, including an automobile insurance plan, behavioral health plan, prescription drug plan, dental plan or vision plan:
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Managed Care Activities means any of the following services or activities, whether provided on paper, in person, electronically, or in any other form and whether performed for or on behalf of the Organization or by the Organization for itself or on behalf of any other party for a fee: Provider Selection; Utilization Review; advertising, marketing, selling, or enrollment for health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans; Claim Services; establishing health care provider networks including tiered networks; provision of information with respect to tiered networks and/or consumer directed health care plans, including cost and quality information regarding specific providers, services and/or charges; reviewing the quality of Medical Services or providing quality assurance; design and/or implementation of financial incentive plans; design and/or implementation of Pay for Performance Programs; wellness or health promotion education; development or implementation of clinical guidelines, practice parameters or protocols; triage for payment of Medical Services; and services or activities performed in the administration or management of health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans.
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Examples of Managed Care Activities in a sentence

  • Table 2.1: Typical Managed Care Activities to Control Costs Gatekeepers/Primary Care Physicians generally coordinate patient care and control patient access to specialists or out-of-network providers based on referral protocols.

  • The professional services exclusion by itself is not a basis for Argonaut to deny its duty to defend.2. Managed Care Activities Exclusion Argonaut next argues it has no duty to defend because of the managed care activities exclusion.

  • The topics presented were as follows: Managed Care Activities, Presentation on Consumer Directed Services for Waiver Services, Updates from DADS and DSHS, Update from HHSC and CMS on 1115 Waiver Activity, Billing Rehab in a Managed Care Environment, Revenue Maximization Committee Update and Public Funds Investment Training was provided.

  • This table summarizes the quality reporting programs, incentive programs, and clinical/performance measure sets that are supported by HCCNs/PCAs. Table 10 – Managed Care Activities.

  • Managed Care Activities UpdateThe Governor has asked DHHS to issue a request for proposal (RFP) to select a managed care company after Mercer, the state’s actuarial consultant, has completed the cost analysis, which is expected by October.

Related to Managed Care Activities

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors:

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Intrascholastic Activities means athletic or non-athletic/academic activities where students compete with students from within the same school.

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Medical Affairs Activities means, with respect to any country or other jurisdiction in the Territory, the coordination of medical information requests and field based medical scientific liaisons with respect to Licensed Compounds or Licensed Products, including activities of medical scientific liaisons and the provision of medical information services with respect to a Licensed Compound or Licensed Product.

  • Extracurricular activities means: a voluntary activity sponsored by the school or local education agency or an organization sanctioned by the local education agency. Extracurricular activities include, but are not limited to, preparation for and involvement in public performances, contests, athletic competitions, demonstrations, displays, and club activities.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Managed Services means the services provided by a Client to End Users using the SaaS and Client’s intellectual capital and/or additional services supplied by Client.

  • Contractor Personnel means Contractor’s employees and subcontractors (as well as any employees or subcontractors of those subcontractors) performing the Services.

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Interscholastic Activities means athletic or non-athletic/academic activities where students compete on a school vs. school basis.

  • Designated chemical dependency specialist means a person

  • Medicaid program means the medical assistance

  • Medical personnel means those persons assigned, by a Party to the conflict, exclusively to the medical purposes enumerated under subparagraph (e) or to the administration of medical units or to the operation or administration of medical transports. Such assignments may be either permanent or temporary. The term includes:

  • Direct care worker means a paid caregiver who provides direct, hands-on personal care services to persons with disabilities or the elderly requiring long-term care.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Educational personnel means persons who must meet requirements pursuant to state law as a condition of employment in educational programs.

  • Managed health care system means: (a) Any health care

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • HMO means health maintenance organization.

  • Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).